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Drug budgets for on-call providers

A high proportion of elderly patients with heart failure can tolerate ?-blockers, according to a new UK study. Researchers studied 226 patients with heart failure and evidence of ventricular systolic dysfunction.

Among patients over the age of 75, 60 per cent had been tried on a ?-blocker and 80 per cent of that group were still taking the treatment. Just under half of patients over 75 had suffered at least one side-effect, but so had 47 per cent of patients under the age of 75.

Age and Ageing 2004;33:467-72

CBT effective after antidepressants

Patients with recurrent depression are significantly less likely to relapse if they are offered cognitive behaviour therapy when antidepressant medication is discontinued, according to a new study.

US researchers assigned 40 patients who had been successfully treated with antidepressants to either fortnightly sessions of CBT for 20 weeks or clinical management. Medication was tapered and discontinued in both groups.

Over the six years of follow-up, the relapse rate was 40 per cent in patients undergoing CBT and 60 per cent in those being managed clinically. Survival rates were also significantly higher in the CBT group.

American Journal of Psychiatry 2004; 161:1872-6

Heatwave deaths occur out of hospital

Increases in mortality caused by heatwaves are not paralleled by a rise in hospitalisations, suggesting many heat-related deaths occur before people get medical attention.

The study found no significant statistical association between temperature patterns and hospital admissions except for respiratory conditions in the under-fives and over-75s. But when the effect of the UK's 1995 heatwave was analysed, researchers found that although hospital admissions rose by a non-significant 2.6 per cent, daily mortality rates increased by 10.8 per cent.

Occupational and Environmental Medicine 2004;61:893-898

Urinary incontinence is hereditary

Women whose mothers or older sisters have urinary incontinence are at increased risk of developing the condition themselves, Norwegian research finds.

The cross-sectional study examined the incidence of urinary incontinence in 6,021 mothers, 7,629 daughters, 332 granddaughters and 2,104 older sisters of 2,426 women. The daughters of mothers with urinary incontinence were 30 per cent more likely than normal to develop the condition.

BMJ 2004;329:889-91

Practice nurse can help dizzy patients

General practice-based vestibular rehabilitation is an effective treatment for dizziness symptoms, according to UK researchers. The randomised controlled trial assigned 170 patients with chronic dizziness from 20 English practices to either vestibular rehabilitation led by practice nurses or to standard care.

Postural stability, symptoms of dizziness and 'dizziness-related handicap' were significantly improved in 67 per cent of treated patients, compared with 38 per cent of patients under usual care.

Annals of Internal Medicine 2004;141:598-605

24-hour indicator of stroke prognosis

Stroke patients who fail to improve within 24 hours of thrombolytic treatment are more likely to die or be in poor health three months later, a study shows.

An analysis of 216 patients admitted to hospital with a stroke found the 51 per cent who failed to improve after thrombolysis were 7.5 times more likely to die and 13 times more likely to have poor health outcomes than those who improved within 24 hours, the Canadian researchers reported.